Scale of a mouse plague

There’s a mouse plague in Australia right now. The words alone don’t express the scale and seriousness of this problem, but this Washington Post piece sure does. The combination of video, photos, and graphics clearly demonstrates the scale. It starts with a pair of mice and escalates quickly from there — and might give you the willies along the way.

Tags: , , , ,

This Is a Test: Georgia Practices for Bioterrorist Threats

Safety officer delivers briefing

It is November 2015, and Georgia’s emergency personnel are preparing to respond to an outbreak of plague.

Don’t worry, it’s not the real plague. This is only a test. No one is actually sick or in any danger. But what if it were real?

Armed with the knowledge that practice makes perfect, the Georgia Department of Public Health is conducting a statewide exercise to test its systems and practice responding to a large-scale public health emergency. In this case, the state is simulating a bioterrorist attack involving an intentional release of the communicable Category A biological agent Yersinia pestis, commonly known as plague. It is a giant effort involving the entire state: all 18 regional emergency operations centers are activating, and they are working closely with CDC.

It’s all pretend, but for those participating, the exercise is very real. There are real phone calls and real trucks and drivers delivering real pallets of materials with real bottles (of pretend medicine). Each pallet and bottle has a real lot number for tracking. Real people – volunteers – will test their ability to dispense medicine quickly in every corner of the state. It’s a critical part of being ready to save lives in case of a bioterrorist attack.

Making the call

America's emergency medical supplies to protect the public's health
America’s emergency medical supplies to protect the public’s health

The exercise begins with a phone call from the Georgia Department of Public Health to the watch desk located inside CDC’s Emergency Operations Center. In an actual event, this would be the first step to set plans in motion.

“When the state makes that first call to request assistance from the Strategic National Stockpile, they need to be able to tell us who, what, when, where, and how many,” explains Pete Alvarez, an emergency management specialist in CDC’s Strategic National Stockpile who helps states coordinate exercises like this one. “The most vital piece of information we need in the beginning is how many people are potentially affected.”

This exercise uses an imaginary, but realistic, scenario: plague has been released by a person, or group of people, dressed as a gardener spraying “pesticide” at several large outdoor events across the state. The aerosolized plague has been detected and now presents a danger to everyone in the community.

The initial phone call reporting the incident to CDC sets off a cascade of activity. The watch desk officer takes note of the relevant information, particularly the large number of patients said to be presenting with symptoms. Immediately, the officer reaches out to CDC’s experts – both subject matter experts in plague and those who manage CDC’s stockpile, the nation’s largest supply of life-saving medicines and medical supplies for use in a public health emergency severe enough to cause local supplies to run out.

Within 30 to 45 minutes, everyone, including CDC leadership, is on the line to discuss the specific health threat, consider the number of people affected, and make the best possible decisions to control the disease right away.

Getting things moving

Plague has a 2-day incubation period, and people who are exposed must receive antibiotic prophylaxis right away. Therefore, once plague is suspected or identified, state and local responders have to act fast. Due to the magnitude of this incident, authorities agree mass amounts of antibiotics from CDC’s stockpile need to be delivered to the affected area as quickly as possible.

Logistics experts with CDC’s stockpile quickly coordinate with commercial transportation partners who will provide trucks to deliver the medicines and relay anticipated delivery timelines to the state.

Meanwhile, a flurry of preparation takes place. While the trucks are on the way, the team in CDC’s stockpile warehouse pulls the requested products and prepares them for pick up. Georgia officials are getting ready to receive and stage the coming shipments. Emergency responders take their stations. Public health officials begins setting up “PODs” – points of dispensing – in public areas and at places of business. This is where people will come to get the medicine. Volunteers, both from the Medical Reserve Corps and the community, line up to act as “patients.”

Testing the system

Volunteers support POD operations
Volunteers support POD operations.

Many of the PODs are set up in large parking lots, at malls, and other places in the community. Some are set up as drive-thrus. People in cars can bring a pre-filled “head of household” form to the line and pick up antibiotics for their whole family. Cars pull up to three stations, one at a time. First is reception, where volunteers hand in their forms. Next is triage, where they answer questions about their health and the health of others who will be taking the antibiotics (a separate line handles those with health concerns, like those who are pregnant or have allergies). Next, they receive a supply of medication to take home.

At least 50 volunteers move through each POD to test how quickly and efficiently the system works. Every person and every bottle of medicine at every station across the state is tracked carefully and logged. The state and regional emergency operations centers stay nimble and ready to add resources or shift focus at a moment’s notice.

While the exercise is taking place, emergency planners insert what are called “injects” into the process. An “inject” is a surprise issue that comes up during the exercise, and it is meant to simulate the kinds of unexpected twists that can happen during a real response. For instance, a team in the field might send a message back to the state emergency operations center that they have not received the right amounts of each antibiotic or that a patient has presented with an allergic reaction to the medicine. Each “inject” tests how a different part of the system will react when things do not go as planned. In an emergency, you have to be ready for anything.

Help from all corners

To make this exercise as real as possible, Georgia invites other partners to join in the activities. They reach out to all the states in FEMA region 4 to figure out how neighboring states can help each other if an emergency like this actually happens.

They conduct a communication drill with ham radio operators in Tennessee, Alabama, Mississippi, and Florida. Ham operators are especially prepared to step in if regular communication channels are compromised, providing a critical lifeline in emergencies.

“We also practiced air transport with the National Guard,” said Charlisa Bell, planning and exercise manager at the Georgia Department of Public Health. “We put the request in through our state operations center. They brought in a Black Hawk, loaded it, and delivered medication to one of our remote districts.”

Lessons learned

In the end, the drill goes off without a hitch. But it teaches a few good lessons along the way, helping the state firm up its plans for staffing, volunteer training, and building security.

“The exercise was well planned and coordinated,” said Alvarez. “The state wanted to know its gaps – public health planners were not afraid of finding out what they needed to improve. They did really well.”

Collaborative exercises like the one in this story are a critical part of keeping our nation’s health secure. The Public Health Emergency Preparedness (PHEP) cooperative agreement provides funding guidance to Georgia and other state and local health departments to help them develop and test response plans so that, when a real event occurs, the state is better prepared to protect its citizens.

7 times public health preparedness proved critical

7 times public health preparedness proved critical | www.APHLblog.org

Our nation’s public health system responds to emergencies such as natural disasters, infectious disease outbreaks, bioterrorism attacks and more both domestically and globally. There’s no way to know what the next threat will be or when it will strike. To quickly and effectively respond to these threats, the public health system – including public health laboratories – must be prepared.

Here are seven stories that highlight the value of public health preparedness and response:

  1. Massive Molasses Mess and the Laboratory Response
  2. Testing for MERS-CoV: The Indiana Lab’s Story
  3. System Built for Responding to Bioterrorism Confirms Plague in Colorado Girl
  4. September 30, 2014: As Ebola Arrived, the Texas Public Health Lab was Ready
  5. Anthrax in Minnesota? The Laboratory Response Network Springs Into Action
  6. Responding to the Animas River disaster: Who’s testing what?
  7. Not Even Superstorm Sandy Could Stop Newborn Screening in New Jersey

Keeping Tabs on Deadly Diseases

Microscopic view of Ebola virusCDC is responsible for protecting the public from a host of health threats, including some pretty scary pathogens, like Ebola virus or anthrax for example. One way we do this is through our Select Agents Program which is responsible for governing and regulating the use of certain pathogens by research facilities and labs around the world. In the beginning of December I had the remarkable opportunity to accompany the inspection team who helps regulate the Select Agents Program on one of their routine lab inspections. I was invited to an inspection of a laboratory in the Southeast region of the U.S. that handles rare and dangerous pathogens to get a glimpse of how the Inspection team operates, what they look for, and what they do to protect us.

Laboratory inspections are an important aspect of the Select Agents Program since they ensure that labs and research facilities are complying with guidelines and regulations specific to biological research. In order to improve our understanding of human health and disease, some laboratories handle rare and potentially dangerous biologic agents and toxins, which are known to cause severe infection, illness, and sometimes death in humans. Laboratories that possess and use these types of biologic agents and toxins for manufacturing purposes, research use, or diagnostics must be registered through this program. When they register with the program, they agree to follow all requirements in the regulation (42 CFR Part 73 – Possession, Use and Transfer of Select Agents and Toxins) including, safety, incident response, security, and having appropriate training in place. CDC’s job is to ensure that all precautions are being taken at laboratories so that the public remain unexposed and unharmed by these potential health threats.

Suiting Up

Man inspecting door sealThe inspection that I joined actually began one week prior to the inspection date when I met with the Inspection Team to prepare a folder with all of the Southeast facility’s biosafety plans, incidence response plans, and security plans. The following week, I flew to the site to meet with the inspection team. I was set to be with the team for the first and most active day of their inspection.

The inspection started with introductions and a briefing among the group. Then there was a visitor’s training to instruct all personnel of potential hazards as well as actions to take in the event of an emergency. To avoid workplace injuries and hazards, personnel must meet all occupational health qualifications. In this laboratory, personnel must perform an exercise test to confirm adequate fitness to wear a respirator. There are two types of respirators at this facility, one that is simply a facemask and another that is a full-body suit. The team thought that I would opt for the full body respirator because it did not require that I shave my beard. However, I gladly accepted the challenge to dawn the facemask respirator (and shave my beard!) to earn my place as member of the team.

Suited up in gowns, gloves, shoe covers, masks and other inspector accessories, we were ready to begin our inspection. Our goal was to go through all of their laboratory space to check that the facility was adhering to appropriate biosafety measures. We checked biological safety cabinets and animal cages, catalogued inventory, and performed other tasks associated with laboratory compliance. Lab personnel graciously halted their work during our visit

The devoted team sought to conduct as much of the laboratory-based inspection as possible the first day. We were successful. After seven hours of tireless work and a brief stint for lunch, we had canvassed the entire facility. The personnel at the Southeast facility were pleasant, welcoming, and grateful for the visit, remarking that they looked forward to an external perspective. Having thoroughly inspected the lab, we finally retired for the day.

A Days Work is Never Done

Man and woman wearing protective gear and holding note books in a laboratory Though I remained for only the first day, the team continued diligently throughout the week. They reviewed all of the Southeast facility’s documents, checked its security, and evaluated its waste, storage, and laboratory maintenance procedures. The team is then responsible for generating a report that lists observations that deviate from regulatory requirements. After much collaboration between the Select Agents Program and the Southeast facility, the Southeast facility is expected to implement changes to receive standard renewal.

I was incredibly impressed with the Select Agents Program’s laboratory inspection. I know that because of them, we can rest assured that high containment facilities operate at the toughest standards. Thanks to this program, the biosafety measures in place consistently enhance the safety and security that the CDC promises to uphold to the American people.